I disturbi del comportamento alimentare: Aspetti eziopatogenetici, clinici e terapeutici

Anorexia nervosa (AN) and bulimia nervosa (BN) are characterised by pathological concerns about body weight (BW) and shape, which usually result in severe food restriction with BW loss in AN and binge-purging behaviours without weight loss in BN. The Diagnostic and Statistical Manual for Mental Disorders Test Revision (DSM-IV TR) includes in the category of eating disorders (EDs) also eating disorders not otherwise specified (EDNOS). EDNOS are represented by partial syndromes not fulfilling all the DSM-IV TR criteria for AN or BN, and by binge-eating disorder (BED), characterised by binge eating without purging or restrictive behaviours, which results in a dramatic BW increase. AN and BN are more prevalent in females than in males, and affect especially adolescents in the age range from 12 to 25 years. The etiopathogenesis of EDs is not known; it is widely believed that both biological, psychological and psychosocial factors contribute to their genesis and/or their maintenance. Among the biological factors, substances involved in the regulation of eating behaviour and energy homeostasis are thought to play a major role, as suggested by both genetic and biochemical studies. From a clinical point of view, AN may lead to severe medical complications, which are threatening for the patient's life; BN is rarely a life frightening condition; in the BED medical complications are similar to those of obesity. Both AN and BN have a high incidence of psychiatric comorbidity, especially affective and anxiety disorders and personality disorders. The treatment of these syndromes requires multiple interventions, which include drugs, psychotherapies, nutritional counselling, psychoeducation and treatment of medical complications. At present, no effective prevention is available.